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MDCT Angiography of the Renal Arteries in Patients with Atherosclerotic Renal Artery Stenosis: Implications for Renal Artery Stenting with Distal Protection

Adam D. Talenfeld1, Ryan B. Schwope, Huntley J. Alper, Emil I. Cohen and Robert A. Lookstein

1 All authors: Division of Interventional Radiology, Mount Sinai Medical Center, One Gustave L. Levy Pl., Box 1234, New York, NY, 10029.


Figure 1
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  		Fig. 1 —76-year-old woman with uncontrolled hypertension. Angiogram shows GuardWire (Medtronic) balloon-occlusion device.

 

Figure 2
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  		Fig. 2 —84-year-old man with worsening renal insufficiency, hypertension, and marked ostial renal artery stenosis. Angiogram shows FilterWire (Boston Scientific) device.

 

Figure 3
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  		Fig. 3 —71-year-old man with malignant hypertension and renal insufficiency. Angiogram shows inadequate diameter of basket and excessive length of wire distal to basket.

 

Figure 4
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  		Fig. 4 —88-year-old man with worsening renal failure and hypertension refractory to treatment with multiple medications. Angiogram shows early branching vessel with little room for stent deployment.

 

Figure 5
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  		Fig. 5 —87-year-old woman with worsening chronic renal insufficiency and ostial renal artery stenosis. Vessel-path curved multiplanar reconstruction image shows atherosclerotic renal artery with ostial plaque, dilatation distal to area of stenosis, and arterial bifurcation. Calcified aortic atherosclerosis is evident.

 

Figure 6
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  		Fig. 6A —Schema for measuring renal artery affected by stenosis due to ostial atherosclerosis. Drawing shows ostial renal artery stenosis.

 

Figure 7
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  		Fig. 6B —Schema for measuring renal artery affected by stenosis due to ostial atherosclerosis. Drawing shows length measurements. L1 = distance from ostium to point of maximum stenosis. L2 = distance from maximum stenosis to renal artery bifurcation. L1 + L2 = effective length of main renal artery.

 

Figure 8
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  		Fig. 6C —Schema for measuring renal artery affected by stenosis due to ostial atherosclerosis. Drawing shows area and diameter measurements. A1 = luminal cross-sectional area at point of maximum stenosis, A2 = luminal cross-sectional area at maximum dilatation distal to point of stenosis, A3 = luminal cross-sectional area immediately proximal to bifurcation, D2 = maximum diameter at point corresponding to A2, D3 = maximum diameter at point corresponding to A3.

 

Figure 9
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  		Fig. 7A —Length results. Length did not vary significantly between men and women but did, as expected, vary significantly between left renal artery and right renal artery. Drawing shows findings for left renal artery.

 

Figure 10
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  		Fig. 7B —Length results. Length did not vary significantly between men and women but did, as expected, vary significantly between left renal artery and right renal artery. Drawing shows findings for right renal artery.

 

Figure 11
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  		Fig. 8A —Mean area and corresponding mean diameter for all subjects. Drawing shows left renal artery.

 

Figure 12
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  		Fig. 8B —Mean area and corresponding mean diameter for all subjects. Drawing shows right renal artery.

 

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